Cataracts and High Myopia: Surgery and Recovery

Cataracts and high myopia?

Hello Dr.
Chen, I have a myopia of 1200 degrees and have been wearing rigid contact lenses for over 20 years.
Recently, my vision has been deteriorating for the past six months.
After a refraction test, I found out that my right eye cannot be corrected.
Following an examination by the doctor, I learned that I have cataracts in both eyes.
I have several questions for Dr.
Chen regarding cataract surgery: How is the surgery performed? How long does it take? What are the risks involved? Is there a chance of recurrence? After cataract surgery, will my vision be corrected? Do both eyes need to be operated on? What is the success rate of the surgery? Does health insurance cover any of the costs? Thank you, Dr.
Chen.

C C J, 40~49 year old female. Ask Date: 2002/02/04

Dr. Chen Xuan reply Ophthalmology

Cataracts and High Myopia Issues? Response to Ms.
C C J regarding her cataracts and high myopia issues.
Cataracts refer to the clouding of the lens inside the eye, leading to blurred vision.
Clinically, cataracts can be classified into several categories, including congenital cataracts (present at birth), metabolic cataracts (due to certain metabolic disorders), cataracts resulting from trauma or inflammation, drug-induced cataracts, and the most common type, age-related cataracts.
Age-related cataracts typically occur around the age of sixty, so the National Health Insurance Administration requires that cataract patients under fifty-five undergo a preliminary examination (including a photo of the affected eye) before coverage is granted.

The surgery is performed through an incision in the cornea or sclera to remove the lens or to use an ultrasound probe to break it up, followed by the insertion of an appropriately powered intraocular lens.
The duration of the surgery varies by individual but generally lasts about an hour.
Medical journals report a success rate of approximately 90% for cataract surgery.
However, systemic conditions such as diabetes, hypertension, and coagulopathy, or other eye diseases like glaucoma and iritis, can increase the risk of intraoperative or postoperative complications.

The quality of vision depends on the coordination of various parts of the eye.
In addition to a successful cataract surgery, the pre-existing condition of the retina (high myopia can lead to retinal and macular degeneration), cornea, and optic nerve will also affect the degree of visual recovery post-surgery.
Generally, if there are no other issues, the visual recovery after cataract surgery is quite satisfactory.

The power of the intraocular lens implanted during cataract surgery will influence the patient's refractive outcome.
Typically, patients may retain myopia of up to 50 to 300 degrees.
For patients with high myopia in both eyes, a common clinical challenge arises if they do not plan to have surgery on both eyes, as this will inevitably lead to a disparity in vision post-surgery.
To balance the refractive power of both eyes before surgery, it is essential to know that if both eyes are operated on, the myopia can be left within 300 degrees or not left at all.
Post-surgery, patients may need reading glasses for near or distance vision.
Some doctors may suggest leaving one eye slightly more myopic (around 200 to 300 degrees) for better near vision, while leaving the other eye minimally myopic (under 50 degrees) for better distance vision, thus potentially eliminating the need for reading glasses after surgery.

A small percentage of patients (about 20% to 25%) may develop secondary cataracts after surgery, which occurs when a membrane grows behind the intraocular lens, affecting its clarity.
This can be easily treated using YAG laser to open the membrane, which takes about one to two minutes and can be done in an outpatient setting.

Dr.
Chen Hsuan, Director of the Cornea Division, Department of Ophthalmology, Hsinchu Hospital, Department of Health.
Response date: 91/02/18.

Reply Date: 2002/02/04

More Info

Cataracts and high myopia present unique challenges when it comes to surgical intervention and recovery. As you have described your situation, it is essential to understand the nature of cataracts, the surgical procedure involved, and the expected outcomes, especially considering your high degree of myopia.

Understanding Cataracts and Surgery:
Cataracts occur when the lens of the eye becomes cloudy, leading to a decrease in vision. This condition is common in older adults but can also develop in individuals with high myopia, as you have experienced. The surgery for cataracts is typically straightforward and involves the removal of the cloudy lens and replacement with an artificial intraocular lens (IOL).
Surgical Procedure:
The surgery is usually performed on an outpatient basis, meaning you can go home the same day. The procedure generally takes about 15 to 30 minutes per eye. During the surgery, the surgeon will use a technique called phacoemulsification, where an ultrasound device breaks up the cloudy lens, which is then suctioned out. After the lens is removed, the IOL is inserted into the eye.
Recovery and Risks:
Post-operative recovery is typically quick, with many patients experiencing improved vision within a few days. However, full recovery can take several weeks. Common risks associated with cataract surgery include infection, bleeding, retinal detachment, and inflammation. While the surgery is generally safe, it is essential to discuss these risks with your ophthalmologist.

Vision Correction Post-Surgery:
Regarding your concern about whether your vision will be corrected after surgery, many patients experience significant improvement in their vision. However, the degree of improvement can vary based on several factors, including the severity of your myopia and the presence of other eye conditions. It is also important to note that while cataract surgery can improve vision, it does not reverse the effects of high myopia.

Bilateral Surgery:
As for whether both eyes need to be operated on, this decision is typically made based on the severity of cataracts in each eye. If both eyes have significant cataracts affecting your vision, it is common to perform surgery on both, often at different times to allow for recovery.

Success Rates and Insurance Coverage:
Cataract surgery has a high success rate, often reported to be over 95%. Most patients achieve 20/40 vision or better after the procedure, which is sufficient for most daily activities. In terms of insurance coverage, Medicare and many private insurance plans typically cover cataract surgery, including the cost of the IOL, but it is advisable to check with your specific insurance provider for details on coverage and out-of-pocket expenses.

Conclusion:
In summary, cataract surgery can significantly improve your vision, even with a history of high myopia. It is crucial to have a thorough discussion with your ophthalmologist about your specific case, including the surgical options available, potential risks, and expected outcomes. They can provide personalized advice based on your eye health and vision needs. Remember to follow post-operative care instructions carefully to ensure the best possible recovery and visual outcome.

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